Study Questions:

What is the incidence of infective endocarditis (IE) in adults with ventricular septal defect (VSD)?

Methods:

The Swedish registry for congenital heart disease (SWEDCON) was searched for adults with VSD. A total of 779 patients were identified, 531 with small shunts and 248 who had the VSD previously closed. The National Patient Register was then searched for hospitalizations due to IE in adults during a 10-year period.

Results:

Sixteen (2%) patients were treated for IE, 6 men and 10 women, with a mean age of 46.3 ± 12.2 years. The incidence of IE was 1.7–2.7/1,000 years in patients without previous intervention, 20–30 times the risk in the general population. Thirteen had small shunts without previous intervention. There was no mortality in these 13 cases. Two patients had undergone repair of their VSD and also aortic valve replacement before the episode of endocarditis, and a third patient with repaired VSD had a bicuspid aortic valve. All of these three patients needed reoperation because of their IE, and one patient died. No patient with isolated and operated VSD was diagnosed with IE.

Conclusions:

The authors concluded that a small unoperated VSD in adults carries a substantially increased risk of IE, but is associated with a low risk of mortality.

Perspective:

This study reports that a small VSD carries a substantially increased risk of IE, that closure of the VSD may reduce this risk, and that IE in cases with a small VSD without previous intervention is associated with a low risk of mortality. Health care providers should be aware that this heart lesion is associated with a high risk of IE. The relative high risk of endocarditis suggests that these patients are seen periodically, although with long intervals, to be informed on, for example, dental hygiene and symptoms of IE.